MEDICARE: DR. PRABHJOT S SIDHU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE-00010707	WA

General Provider Information

NPI Number	:	1467646497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRABHJOT S SIDHU DDS

Provider Business Mailing Address
First Line	:	3870 82ND AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3539
Country	:	US
Telephone Number	:	347-453-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	18910 28TH AVE W STE 202
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4701
Country	:	US
Telephone Number	:	425-775-5557
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	10/02/2007

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